I 

116TH CONGRESS 

1ST SESSION H. R. 2778 

To amend title XXVII of the Public Health Service Act to provide for 

a special enrollment period for pregnant women, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 15, 2019 

Mrs. WATSON COLEMAN (for herself, Ms. ADAMS, Ms. BARRAGA ́N, Ms. 

BONAMICI, Ms. CLARK of Massachusetts, Ms. CLARKE of New York, Mr. 

COHEN, Mr. CONNOLLY, Ms. DELBENE, Mrs. DINGELL, Mr. MICHAEL

F. DOYLE of Pennsylvania, Mr. ENGEL, Mr. ESPAILLAT, Mr. FOSTER, 

Ms. FRANKEL, Mr. GALLEGO, Mr. GRIJALVA, Ms. HAALAND, Mr. HASTINGS, Ms. JACKSON LEE, Ms. KELLY of Illinois, Mr. KHANNA, Mrs. 

KIRKPATRICK, Mr. LANGEVIN, Mrs. LAWRENCE, Ms. LEE of California, 

Mr. LEWIS, Ms. MCCOLLUM, Ms. MENG, Mr. SEAN PATRICK MALONEY

of New York, Ms. MOORE, Mr. MOULTON, Mr. NADLER, Ms. NORTON, 

Mr. PASCRELL, Mr. RASKIN, Ms. ROYBAL-ALLARD, Mr. RYAN, Mr. 

SCHIFF, Mr. TONKO, Mr. TRONE, Ms. WILSON of Florida, Ms. 

WASSERMAN SCHULTZ, Ms. VELA ́ZQUEZ, Mrs. BEATTY, Mr. VEASEY, Mr. 

VARGAS, Mr. BROWN of Maryland, Ms. BASS, Mr. THOMPSON of Mississippi, and Mr. RICHMOND) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to 

the Committees on Ways and Means, Oversight and Reform, and Education and Labor, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend title XXVII of the Public Health Service Act 

to provide for a special enrollment period for pregnant 

women, and for other purposes. 


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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Healthy Maternity and 

5 Obstetric Medicine Act’’ or the ‘‘Healthy MOM Act’’. 

6 SEC. 2. FINDINGS AND PURPOSE. 

7 (a) FINDINGS.—Congress finds the following: 

8 (1) Pregnancy is a significant life event for mil9 lions of women in the United States each year. 

10 (2) For more than 30 years, our Nation, 

11 through the Medicaid program, has recognized that 

12 pregnant women need immediate access to afford13 able care, and has allowed women who meet income14 eligibility requirements to enroll in Medicaid cov15 erage when they become pregnant. 

16 (3) Congress recognized the central importance 

17 of maternity coverage by classifying maternity and 

18 newborn care as one of the ten essential health bene19 fits that must now be covered on most individual 

20 and small group health insurance plans under sec21 tion 1302(b)(1) of the Patient Protection and Af22 fordable Care Act (42 U.S.C. 18022(b)(1)). 

23 (4) Congress has also recognized the significant 

24 challenge of maternal mortality and the need to 

25 eliminate disparities in maternal health outcomes for 


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1 pregnancy-related and pregnancy-associated deaths, 

2 and to improve health outcomes for both mothers 

3 and babies through passage of the Preventing Ma4 ternal Deaths Act of 2018 (Public Law 115–344). 

5 (5) Access to comprehensive maternity coverage 

6 allows women to access important pregnancy-related 

7 care, which is demonstrated to improve health out8 comes for women and newborns and reduce financial 

9 costs for both consumers and insurers. 

10 (6) Uninsured women, women with grand11 fathered and transitional health plans, self-funded 

12 student health plans, and catastrophic and high-de13 ductible health plans may lack access to comprehen14 sive and affordable maternity coverage. 

15 (7) Employer health plans that exclude depend16 ent daughters from maternity coverage leave young 

17 women without coverage for their pregnancy, even 

18 though Federal law has long held that treating preg19 nancy differently than other conditions is sex-based 

20 discrimination. 

21 (8) A special enrollment period is especially im22 portant for young adults, who are at high risk for 

23 unintended pregnancies, yet young adults are fre24 quently enrolled in catastrophic coverage, which 


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1 often has fewer benefits, more restrictions, and high2 er deductibles. 

3 (9) This coverage would be an equalizer for 

4 communities of color. The maternal mortality rate 

5 varies drastically by race and ethnicity, and where a 

6 woman lives. The rising maternal mortality rate in 

7 the United States is driven predominantly by the 

8 disproportionately high African-American maternal 

9 mortality rate, which is four times more than the 

10 rate for White women. 

11 (10) According to the Centers for Disease Con12 trol and Prevention, about 700 women die each year 

13 in the United States from pregnancy-related com14 plications. Black and American Indian/Alaska Native 

15 women are about three times more likely to die from 

16 a pregnancy-related cause than White women. 

17 (11) Data demonstrates that 3 in 5 pregnancy 

18 related deaths could be prevented. Improving access 

19 to care is one way to help prevent deaths, regardless 

20 of race or ethnicity. 

21 (12) Timely maternity care improves the health 

22 of pregnant women, as well as birth outcomes and 

23 the health of babies throughout their lifetimes. Preg24 nancy-related maternal mortality is three to four 

25 times higher among women who receive no maternity 


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1 care compared to women who do. Regular maternity 

2 care can detect or mitigate serious pregnancy-related 

3 health complications, including preeclampsia, pla4 cental abruption, complications from diabetes, com5 plications from heart disease, and Graves’ disease, 

6 all of which can result in morbidity or mortality for 

7 the mother or newborn. 

8 (13) The Centers for Disease Control and Pre9 vention reports that more than half of all maternal 

10 deaths occur at delivery or in the first postpartum 

11 year, whereas just more than one-third of preg12 nancy-related or pregnancy-associated deaths occur 

13 while a person is still pregnant. Yet, for women eligi14 ble for the Medicaid program on the basis of preg15 nancy, such Medicaid coverage lapses at the end of 

16 the month on which the 60th postpartum day lands. 

17 (14) Timely maternity care and adequate 

18 postpartum care can reduce short- and long-term 

19 health care costs. If a woman does not have access 

20 to affordable maternity care during her pregnancy, 

21 and she or her newborn experiences pregnancy com22 plications that result in health problems after birth, 

23 their insurer may end up paying much higher costs 

24 than if the insurer had covered the woman’s mater25 nity care during her pregnancy. Intensive maternity 


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1 care can reduce hospital and neonatal intensive care 

2 unit admissions among infants, resulting in cost sav3 ings of $1,768 to $5,560 per birth. For women with 

4 high-risk pregnancies, intensive maternity care saves 

5 $1.37 for every $1 invested in maternity care. 

6 (b) PURPOSE.—The purpose of this Act is to protect 

7 the health of women and newborns by ensuring that all 

8 women eligible for coverage through the Exchanges estab9 lished under title I of the Patient Protection and Afford10 able Care Act (Public Law 111–148) and women eligible 

11 for other individual or group health plan coverage can ac12 cess affordable health coverage during their pregnancy. 

13 SEC. 3. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD 

14 FOR PREGNANT INDIVIDUALS. 

15 (a) PUBLIC HEALTH SERVICE ACT.—Section 

16 2702(b)(2) of the Public Health Service Act (42 U.S.C. 

17 300gg–1(b)(2)) is amended by inserting ‘‘including a spe18 cial enrollment period for pregnant individuals, beginning 

19 on the date on which the pregnancy is reported to the 

20 health insurance issuer’’ before the period at the end. 

21 (b) PATIENT PROTECTION AND AFFORDABLE CARE

22 ACT.—Section 1311(c)(6) of the Patient Protection and 

23 Affordable Care Act (42 U.S.C. 18031(c)(6)) is amend24 ed— 


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1 (1) in subparagraph (C), by striking ‘‘and’’ at 

2 the end; 

3 (2) by redesignating subparagraph (D) as sub4 paragraph (E); and 

5 (3) by inserting after subparagraph (C) the fol6 lowing new subparagraph: 

7 ‘‘(D) a special enrollment period for preg8 nant individuals, beginning on the date on 

9 which the pregnancy is reported to the Ex10 change; and’’. 

11 (c) SPECIAL ENROLLMENT PERIODS.— 

12 (1) INTERNAL REVENUE CODE.—Section 

13 9801(f) of the Internal Revenue Code of 1986 (26 

14 U.S.C. 9801(f)) is amended by adding at the end 

15 the following new paragraph: 

16 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 

17 ‘‘(A) A group health plan shall permit an 

18 employee who is eligible, but not enrolled, for 

19 coverage under the terms of the plan (or a de20 pendent of such an employee if the dependent 

21 is eligible, but not enrolled, for coverage under 

22 such terms) to enroll for coverage under the 

23 terms of the plan upon pregnancy, with the spe24 cial enrollment period beginning on the date on 

25 which the pregnancy is reported to the group 


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1 health plan or the pregnancy is confirmed by a 

2 health care provider. 

3 ‘‘(B) The Secretary shall promulgate regu4 lations with respect to the special enrollment 

5 period under subparagraph (A), including es6 tablishing a time period for pregnant individ7 uals to enroll in coverage and effective date of 

8 such coverage.’’. 

9 (2) ERISA.—Section 701(f) of the Employee 

10 Retirement Income Security Act of 1974 (29 U.S.C. 

11 1181(f)) is amended by adding at the end the fol12 lowing: 

13 ‘‘(4) FOR PREGNANT INDIVIDUALS.— 

14 ‘‘(A) A group health plan or health insur15 ance issuer in connection with a group health 

16 plan shall permit an employee who is eligible, 

17 but not enrolled, for coverage under the terms 

18 of the plan (or a dependent of such an employee 

19 if the dependent is eligible, but not enrolled, for 

20 coverage under such terms) to enroll for cov21 erage under the terms of the plan upon preg22 nancy, with the special enrollment period begin23 ning on the date on which the pregnancy is re24 ported to the group health plan or health insurVerDate Sep 11 2014 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2778.IH H2778

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1 ance issuer or the pregnancy is confirmed by a 

2 health care provider. 

3 ‘‘(B) The Secretary shall promulgate regu4 lations with respect to the special enrollment 

5 period under subparagraph (A), including es6 tablishing a time period for pregnant individ7 uals to enroll in coverage and effective date of 

8 such coverage.’’. 

9 (d) EFFECTIVE DATE.—The amendments made by 

10 this section shall apply with respect to plan years begin11 ning after the 2019 plan year. 

12 SEC. 4. COVERAGE OF MATERNITY CARE FOR DEPENDENT 

13 CHILDREN. 

14 Section 2719A of the Public Health Service Act (42 

15 U.S.C. 300gg–19a) is amended by adding at the end the 

16 following: 

17 ‘‘(e) COVERAGE OF MATERNITY CARE.—A group 

18 health plan, or health insurance issuer offering group or 

19 individual health insurance coverage, that provides cov20 erage for dependants shall ensure that such plan or cov21 erage includes coverage for maternity care associated with 

22 pregnancy, childbirth, and postpartum care for all partici23 pants, beneficiaries, or enrollees, including dependants, in24 cluding coverage of labor and delivery. Such coverage shall 

25 be provided to all pregnant dependents regardless of age.’’. 


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1 SEC. 5. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 

2 (a) COVERAGE OF PREGNANCY.— 

3 (1) IN GENERAL.—The Director of the Office of 

4 Personnel Management shall issue such regulations 

5 as are necessary to ensure that pregnancy is consid6 ered a change in family status and a qualifying life 

7 event for an individual who is eligible to enroll, but 

8 is not enrolled, in a health benefit plan under chap9 ter 89 title 5, United States Code. 

10 (2) EFFECTIVE DATE.—The requirement in 

11 paragraph (1) shall apply with respect to any con12 tract entered into under section 8902 of such title 

13 beginning 12 months after the date of enactment of 

14 this Act. 

15 (b) DESIGNATING CERTAIN FEHBP-RELATED

16 SERVICES AS EXCEPTED SERVICES UNDER THE ANTI17 DEFICIENCY ACT.— 

18 (1) IN GENERAL.—Section 8905 of title 5, 

19 United States Code, is amended by adding at the 

20 end the following: 

21 ‘‘(i) Any services by an officer or employee under this 

22 chapter relating to enrolling individuals in a health bene23 fits plan under this chapter, or changing the enrollment 

24 of an individual already so enrolled due to an event de25 scribed in section 5(a)(1) of the Healthy MOM Act, shall 

26 be deemed, for purposes of section 1342 of title 31, servVerDate Sep 11 2014 00:34 May 30, 2019 Jkt 034408 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2778.IH H2778

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1 ices for emergencies involving the safety of human life or 

2 the protection of property.’’. 

3 (2) APPLICATION.—The amendment made by 

4 paragraph (1) shall apply to any lapse in appropria5 tions beginning on or after the date of enactment of 

6 this Act. 

7 SEC. 6. CONTINUATION OF MEDICAID INCOME ELIGIBILITY 

8 STANDARD FOR PREGNANT INDIVIDUALS 

9 AND INFANTS. 

10 Section 1902(l)(2)(A) of the Social Security Act (42 

11 U.S.C. 1396a(l)(2)(A)) is amended— 

12 (1) in clause (i), by striking ‘‘and not more 

13 than 185 percent’’; 

14 (2) in clause (ii)— 

15 (A) in subclause (I), by striking ‘‘and’’ 

16 after the comma; 

17 (B) in subclause (II), by striking the pe18 riod at the end and inserting ‘‘, and’’; and 

19 (C) by adding at the end the following: 

20 ‘‘(III) January 1, 2020, is the percentage pro21 vided under clause (v).’’; and 

22 (3) by adding at the end the following new 

23 clause: 

24 ‘‘(v) The percentage provided under clause (ii) for 

25 medical assistance provided on or after January 1, 2020, 


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1 with respect to individuals described in subparagraph (A) 

2 or (B) of paragraph (1) shall not be less than— 

3 ‘‘(I) the percentage specified for such individ4 uals by the State in an amendment to its State plan 

5 (whether approved or not) as of January 1, 2014; or 

6 ‘‘(II) if no such percentage is specified as of 

7 January 1, 2014, the percentage established for 

8 such individuals under the State’s authorizing legis9 lation or provided for under the State’s appropria10 tions as of that date.’’. 

11 SEC. 7. 12-MONTH CONTINUOUS COVERAGE FOR PREG12 NANT AND POSTPARTUM INDIVIDUALS 

13 UNDER MEDICAID AND CHIP. 

14 (a) MEDICAID.— 

15 (1) REQUIRED FOR ALL ELIGIBILITY PATH16 WAYS.—Paragraph (5) of section 1902(e) of the So17 cial Security Act (42 U.S.C. 1396a(e)) is amended 

18 to read as follows: 

19 ‘‘(5) Any individual who is eligible for medical assist20 ance under the State plan or a waiver of such plan and 

21 who is, or who while so eligible becomes, pregnant shall 

22 continue to be eligible under the plan or waiver for medical 

23 assistance that provides at least essential health benefits 

24 as described in section 1302(b) of the Patient Protection 

25 and Affordable Care Act, through the end of the month 


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1 in which the 1-year period (beginning on the last day of 

2 her pregnancy) ends, regardless of the basis for the indi3 vidual’s eligibility for medical assistance, including if the 

4 individual’s eligibility for medical assistance is on the basis 

5 of being pregnant.’’. 

6 (2) CONFORMING AMENDMENTS.—Title XIX of 

7 the Social Security Act (42 U.S.C. 1396 et seq.) is 

8 amended— 

9 (A) in section 1902— 

10 (i) in subsection (a)(10), in the mat11 ter following subparagraph (G) by striking 

12 ‘‘(VII) the medical assistance’’ and all that 

13 follows through ‘‘complicate pregnancy,’’; 

14 (ii) in subsection (e)(6), by striking 

15 ‘‘60-day’’ and inserting ‘‘1-year’’; and 

16 (iii) in subsection (l)(1)(A), by strik17 ing ‘‘60-day’’ and inserting ‘‘1-year’’; 

18 (B) in section 1903(v)(4)(A)(i), by striking 

19 ‘‘60-day’’ and inserting ‘‘1-year’’; and 

20 (C) in section 1905(a), in the 4th sentence 

21 in the matter following paragraph (30), by 

22 striking ‘‘60-day’’ and inserting ‘‘1-year’’. 

23 (b) CHIP.— 


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1 (1) IN GENERAL.—Section 2107(e)(1) of the 

2 Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

3 amended— 

4 (A) by redesignating subparagraphs (H) 

5 through (S) as subparagraphs (I) through (T), 

6 respectively; and 

7 (B) by inserting after subparagraph (G), 

8 the following: 

9 ‘‘(H) Section 1902(e)(5) (requiring 12- 

10 month continuous coverage for pregnant indi11 viduals).’’. 

12 (2) CONFORMING AMENDMENTS.—Subsections 

13 (d)(2)(A) and (f)(2) of section 2112 of the Social 

14 Security Act (42 U.S.C. 1397ll) are each amended 

15 by striking ‘‘60-day’’ and inserting ‘‘1-year’’. 

16 (c) EFFECTIVE DATE.— 

17 (1) IN GENERAL.—Subject to paragraph (2), 

18 the amendments made by this section shall take ef19 fect on the 1st day of the 1st calendar quarter that 

20 begins on or after the date that is 1 year after the 

21 date of enactment of this Act. 

22 (2) EXCEPTION FOR STATE LEGISLATION.—In 

23 the case of a State plan under title XIX of the So24 cial Security Act or a State child health plan under 

25 title XXI of such Act that the Secretary of Health 


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1 and Human Services determines requires State legis2 lation in order for the respective plan to meet any 

3 requirement imposed by amendments made by this 

4 section, the respective plan shall not be regarded as 

5 failing to comply with the requirements of such title 

6 solely on the basis of its failure to meet such an ad7 ditional requirement before the first day of the first 

8 calendar quarter beginning after the close of the 

9 first regular session of the State legislature that be10 gins after the date of enactment of this Act. For 

11 purposes of the previous sentence, in the case of a 

12 State that has a 2-year legislative session, each year 

13 of the session shall be considered to be a separate 

14 regular session of the State legislature. 

15 SEC. 8. RELATIONSHIP TO OTHER LAWS. 

16 Nothing in this Act (or an amendment made by this 

17 Act) shall be construed to invalidate or limit the remedies, 

18 rights, and procedures of any Federal law or the law of 

19 any State or political subdivision of any State or jurisdic20 tion that provides greater or equal protection for enrollees 

21 in a group health plan or group or individual health insur22 ance offered by a health insurance issuer. 

Æ 


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